A Persistent and Growing Crisis
According to the U.S. Pharmacopeia's Annual Drug Shortages Report in May 2025, the average duration of a drug shortage has now increased to over four years, up from roughly three years in 2023. This highlights that the problem is not a series of isolated incidents but a systemic issue rooted deep within the pharmaceutical supply chain. While some shortages, like those involving GLP-1 agonists, have been partially resolved due to increased production and shifting market dynamics, many other crucial medications, particularly generics, remain affected.
Current Medications in Shortage in 2025
Several key therapeutic areas continue to be hit by shortages in 2025. Lists published by health-system organizations like ASHP and resources such as Drugs.com show a wide variety of affected drugs.
- Oncology Medications: Chemotherapy drugs like Methotrexate and Carboplatin injections have been repeatedly affected. These shortages are particularly critical, as delays or substitutions in cancer treatment can have devastating effects on patient outcomes.
- Sterile Injectables: A broad category of generic sterile injectable medications, including Lidocaine, Epinephrine, and various forms of Dextrose and Sodium Chloride injections, continue to be in short supply. These are vital for hospital settings, surgeries, and emergency care. The American Hospital Association noted a shortage of IV fluids earlier in the year, partly due to extreme weather events impacting manufacturing plants.
- ADHD Medications: The shortage of ADHD stimulants has been a persistent issue. As of September 2025, Lisdexamfetamine Dimesylate capsules remain on the shortage list, with various manufacturers affected. This was initially driven by a significant demand increase and manufacturing delays.
- Insulin: A specific recombinant insulin, Insulin Glargine-yfgn, manufactured by Biocon, has experienced a shortage due to increased market demand after competitors exited the market. While resupply is expected by late 2025 for some formulations, supply interruptions have impacted patients.
- Anesthetics and Pain Management: Injectable forms of drugs like Hydromorphone, Fentanyl, and Midazolam have been on and off shortage lists throughout the year, posing challenges for procedural sedation and pain management in hospitals.
The Multifaceted Causes of Drug Shortages
The reasons behind the enduring drug shortage crisis are complex and interconnected. Several factors conspire to create a fragile supply chain susceptible to disruption.
Manufacturing and Supply Chain Vulnerabilities
- Consolidated Manufacturing: The pharmaceutical industry has consolidated its manufacturing, with many generic drugs produced by only a few companies or a single factory. When a single facility has a problem, it can trigger a nationwide shortage.
- Overseas Reliance: The U.S. remains heavily reliant on overseas manufacturers, particularly in China and India, for Active Pharmaceutical Ingredients (APIs) and finished products. Geopolitical tensions, trade policies (like tariffs), and other disruptions in these regions can have a significant and immediate impact on U.S. drug availability.
- Quality Control Issues: Manufacturing quality issues, sometimes identified during FDA inspections, can lead to production halts and recalls. The FDA can only move so quickly to inspect and resolve these issues.
Economic and Market Pressures
- Low Profit Margins: Many generic, essential drugs are older and have very low profit margins. This makes them less attractive for manufacturers, who may not invest in facility upgrades or capacity expansion, leaving production lines vulnerable.
- Market Discontinuation: When a drug is not profitable, a manufacturer may choose to discontinue it. In some cases, as with a specific morphine formulation, this decision can lead to or worsen a shortage, especially if other manufacturers cannot absorb the demand.
External and Demand-Driven Factors
- Natural Disasters: Extreme weather events, such as hurricanes or tornadoes, can severely damage manufacturing facilities, as seen in the past with a Pfizer plant in North Carolina. Such damage can cripple the supply of multiple critical drugs.
- Demand Surges: Unanticipated increases in demand, such as those seen for ADHD and GLP-1 drugs, can quickly outstrip a manufacturer's capacity, especially if other factors like manufacturing delays are also at play.
Comparison of Selected Drugs in Shortage, 2025
| Generic Name | Therapeutic Area | Primary Use | Key Shortage Causes (2025) | Impact |
|---|---|---|---|---|
| Lisdexamfetamine Dimesylate Capsules | CNS Agents | ADHD | Increased demand, manufacturing delays. | Disruption of treatment, potential for misuse of alternatives. |
| Methotrexate Injection | Oncology | Chemotherapy, autoimmune disease | Manufacturing issues, reliance on overseas API sources. | Treatment delays, compromised patient outcomes for cancer patients. |
| Sterile Injectables (IV Fluids) | Fluids and Electrolytes | Hospital/Surgical Care | Natural disasters affecting manufacturing sites, supply chain issues. | Hospital operational disruptions, increased patient risk. |
| Insulin Glargine-yfgn (Biocon) | Hormonal Agents | Type 1 and 2 Diabetes | Increased market demand following competitor exits, production expansion ongoing. | Requires alternative therapy management, risk of poor glycemic control. |
| Clonazepam Tablets | CNS Agents | Anxiety, seizures | Manufacturing and supply chain challenges. | Potential for treatment instability for chronic conditions. |
Mitigation Strategies and The Way Forward
Addressing the drug shortage crisis requires a coordinated effort involving regulators, manufacturers, and healthcare providers. Organizations like the American College of Physicians (ACP) and ASHP have called for significant policy changes.
Here are some of the ongoing and proposed solutions:
- Increasing Domestic Manufacturing: The U.S. is working to incentivize and expand domestic production of essential medicines and APIs to reduce reliance on vulnerable global supply chains.
- Enhancing Supply Chain Transparency: Better data sharing and visibility across the supply chain can help predict and prevent shortages before they become critical.
- Alternative Production Methods: The FDA has issued guidance on alternative inspection tools and regulatory flexibility to keep production lines running smoothly and address quality issues more efficiently.
- Prioritizing Public Policy: The ACP recommends policy approaches that strengthen supply chains, prioritize equitable medication distribution during shortages, and reward quality over lowest-cost purchasing practices.
- Utilizing Alternative Therapies: In cases of shortage, clinicians often must pivot to alternative drugs, sometimes with unfamiliar side effects or administration protocols, increasing the risk of medication errors. Careful communication and patient education are essential.
Conclusion
The question of what drug is currently in shortage in 2025? highlights a deeper systemic problem rather than a temporary inconvenience. It points to a fragile supply chain heavily influenced by manufacturing vulnerabilities, global dependencies, and market economics. While some shortages are eventually resolved, the persistent nature of the crisis, impacting critical areas like oncology and emergency care, poses significant risks to patient safety and access. The path forward involves a multi-pronged approach that strengthens domestic manufacturing, increases supply chain resilience, and fosters collaboration among all healthcare stakeholders to ensure a more stable medication supply for the future.
